The oral component of Sjögren’s syndrome: Pass the scalpel and check the water

Abstract

The labial salivary gland biopsy is a diagnostic test for the oral component of Sjögren's syndrome (SS) that has been the subject of controversy and re-examination for many years. Despite multiple recent challenges to the significance of this test, when correctly done, it remains one of the most informative, specific, and technically simple tests available for the oral component of SS. Because of compromised salivary gland function, patients with SS are at risk for dental caries. Within the past decade, a paradigm shift has occurred within the field of caries research. The caries process was previously thought irreversible once initiated. Research has shown that the "early" carious lesion can be remineralized. Thus, the "early" carious lesion may be prevented and even repaired. The process of remineralization requires appropriate conditions to occur, and one of those conditions is pH. Because water is often the preferred wetting agent/beverage for patients with SS, the data show that, with regard to pH, not all waters are created equal.

Sjögren’s Syndrome

“…A double-blind clinical trial examined the efficacy of a dentifrice containing calcium phosphate and found modest benefit in the prevention of root caries, but no benefit on coronal caries was noted (Wu, 2003). These findings are consistent with the observation that individuals with salivary dysfunction are prone to root and incisal caries, rather than coronal caries.…”

“…The loss of teeth in SS patients results from a combination of low oral pH that facilitates loss of dental calcium and the alterations of oral flora that lead to accelerated decay (Suzuki et al, 2005;Soto-Rojas and Kraus, 2002;Christensen et al, 2001;Schiodt et al, 2001;Isidor et al, 1999;Robinson et al, 1997;Yamamoto et al, 1997). These problems have been recently reviewed by Wu et al (Wu and Fox, 1994;Wu, 2003). For individuals with very low to no salivary production, the amount of phosphate and calcium ions available for incorporation onto the tooth surface and enhancement of the remineralization process may be limited.…”

“…The mouthwash failed to show complete efficacy (Wu, 2003). The majority of studies supporting the addition of calcium and phosphate as an aid to remineralization have been primarily short-term studies in animals and humans.…”

“…Convincing data primarily from studies done with children has shown that certain natural sweeteners such as xylitol and sorbitol (usually in a chewing gum formulation) have a significant anti-caries effect. There has been some suggestion that the cariespreventative effect of xylitol/sorbitol is due to the effect of chewing alone, via the production of saliva (Wu and Fox, 1994;Wu, 2003). But other mechanisms have been suggested including: the growth inhibition of caries-inducing bacteria, the selection of xylitol-resistant strains with a resultant shift to less virulent and cariogenic strains, and the binding of xylitol to surface receptors on Strep.…”

“…One in-vitro study determined that a single application of the varnish could release fluoride for up to 6 months (Wu, 2003). Varnish application is fast and easy and does not necessarily require professional prophylaxis prior to application, and can be applied directly to the root and incisal surfaces that are most vulnerable to decay in the SS patient population (Castillo and Milgrom, 2004;Castillo et al, 2001).…”